NPWTRCT.docx

1、NPWTRCTGene expression profiling of negative-pressure-treated skin graft donor site wounds.Nuutila K, Siltanen A, Peura M, Harjula A, Nieminen T, Vuola J, Kankuri E, Aarnio P.SourceInstitute of Biomedicine, Pharmacology, Biomedicum, University of Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland.

2、kristo.nuutilahelsinki.fiAbstractNegative-pressure wound therapy (NPWT) is widely used to improve skin wound healing. Although NPWT has been studied as a treatment for wound closure and healing, the molecular mechanisms explaining its therapeutic effects remain unclear. To investigate the effect of

3、NPWT on gene expression, and to discover the genes most dominantly responding to this treatment during skin wound healing, we applied negative pressure on split-thickness skin graft donor sites from the first postoperative day (POD) to the seventh POD. Biopsies were collected from 4 NPWT-treated and

4、 2 control patients. Two biopsy samples were taken from each patient: one from intact skin before graft harvesting, and one on the seventh POD from the donor site wound. Genome-wide microarrays were performed on all samples. Gene expression changes on the seventh POD were compared between NPWT and c

5、ontrol patients, and were analyzed for statistical significance. In addition, we analyzed wound exudates for volume, and for concentrations of leukocytes, erythrocytes, and haemoglobin. NPWT induced major changes in gene expression during healing. These changes ranged from 10-fold induction to 27-fo

6、ld suppression. The genes most induced were associated with cell proliferation and inflammation, and the most down-regulated genes were linked to epidermal differentiation. Our results provide the first insight into the molecular mechanisms behind NPWT, and suggest that NPWT enhances specific inflam

7、matory gene expression at the acute phase associated with epithelial migration and wound healing. However, its continued use may inhibit epithelial differentiation.Copyright 2012 Elsevier Ltd and ISBI. All rights reserved.PMID: 23141686 PubMed - indexed for MEDLINEClinical evaluation of gauze-based

8、negative pressure wound therapy in challenging wounds.Tuncel U, Erkorkmaz , Turan A.SourceU Tuncel, Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Gaziosmanpaa University, Tokat 60150, Turkey. drumuttuncelAbstractThe aim of this randomised clinical study was to eval

9、uate the effectiveness and safety of gauze-based negative pressure wound therapy (NPWT) in patients with challenging wounds. A total of 50 consecutive patients who had wound drainage for more than 5 days, required open wound management and had existence of culture positive infection were included th

10、e study. In this study, gauze-based NPWT was compared with conventional dressing therapy in the treatment of patients with difficult-to-heal wounds. The patients were randomly divided into two groups. Group I (n = 25) was followed by conventional antiseptic (polyhexanide solution) dressings, and gro

11、up II (n = 25) was treated with saline-soaked antibacterial gauze-based NPWT. The wounds sizes, number of debridement, bacteriology and recurrence were compared between group I and group II. The mean age of the patients was 5950 years (range 23-97). In group I, average wound sizes of pre- and post-t

12、reatment periods were 5060 5535 and 4250 4792 cm(2), respectively (P 0001). Average duration of treatment was 2552 1699 days, and average wound size reduction following the treatment was 1999% in this group. In group II, the wounds displayed considerable shrinkage, accelerated granulation tissue for

13、mation, decreased and cleared away exudate. The average wound sizes in the pre- and post-treatment periods were 9844 10088 and 7208 7578 cm(2) , respectively (P 0001). Average duration of treatment was 1196 248 days, and average wound size reduction following the treatment was 3234%. The patients tr

14、eated with antibacterial gauze-based NPWT had a significantly reduced recurrence (2 wounds versus 14 wounds, P = 0001), and increased number of the culture-negative cases (22 wounds versus 16 wounds, P 0.05). No complications occurred in either group. By an almost identical supply agreement of both

15、providers for our hospital RENASYS system appeared to be more cost-effective.CONCLUSION: After a long period of preserving a monopoly market position of the V.A.C. system, a new comparable option was successfully tested in this preliminary study. The polyurethane foam-based NPWT system (RENASYS GO -

16、 F/P, Smith & Nephew GmbH) is an efficient and cost-effective alternative NPWT system, which we effectively implemented in therapeutic management of different kinds of wounds.A pilot randomised controlled trial of negative pressure wound therapy to treat grade III/IV pressure ulcers ISRCTN69032034.A

17、shby RL, Dumville JC, Soares MO, McGinnis E, Stubbs N, Torgerson DJ, Cullum N.SourceDepartment of Health Sciences, The University of York, York, UK.AbstractBACKGROUND: Negative pressure wound therapy (NPWT) is widely promoted as a treatment for full thickness wounds; however, there is a lack of high

18、-quality research evidence regarding its clinical and cost effectiveness. A trial of NPWT for the treatment of grade III/IV pressure ulcers would be worthwhile but premature without assessing whether such a trial is feasible. The aim of this pilot randomised controlled trial was to assess the feasib

19、ility of conducting a future full trial of NPWT for the treatment of grade III and IV pressure ulcers and to pilot all aspects of the trial.METHODS: This was a two-centre (acute and community), pilot randomised controlled trial. Eligible participants were randomised to receive either NPWT or standar

20、d care (SC) (spun hydrocolloid, alginate or foam dressings). Outcome measures were time to healing of the reference pressure ulcer, recruitment rates, frequency of treatment visits, resources used and duration of follow-up.RESULTS: Three hundred and twelve patients were screened for eligibility into

21、 this trial over a 12-month recruitment period and 12/312 participants (3.8%) were randomised: 6 to NPWT and 6 to SC. Only one reference pressure ulcer healed (NPWT group) during follow-up (time to healing 79days). The mean number of treatment visits per week was 3.1 (NPWT) and 5.7 (SC); 6/6 NPWT an

22、d 1/6 SC participants withdrew from their allocated trial treatment. The mean duration of follow-up was 3.8 (NPWT) and 5.0 (SC) months.CONCLUSIONS: This pilot trial yielded vital information for the planning of a future full study including projected recruitment rate, required duration of follow-up

23、and extent of research nurse support required. Data were also used to inform the cost-effectiveness and value of information analyses, which were conducted alongside the pilot trial.Do patient and nurse outcome differences exist between 2 negative pressure wound therapy systems?Albert NM, Rock R, Sa

24、mmon MA, Bena JF, Morrison SL, Whitman A, Kato I, Landis-Erdman JC.SourceNursing Institute, Cleveland Clinic, Ohio 44195, USA. albertnccf.orgAbstractPURPOSE: We prospectively compared the effectiveness of foam- and gauze-based negative pressure wound therapy (NPWT) systems on wound healing, pain, co

25、st, and hospital length of stay. We also compare ease of use and time in performing dressing changes reported by nurses.DESIGN: Randomized, controlled clinical trial comparing foam- and gauze-based NPWT systems.SUBJECTS AND SETTING: Eleven adult subjects with physician orders for NPWT participated in the study. Subjects were middle-aged, white, and male.METHODS: Six subjects were randomly allocated to foam-based and 5 to gau